Elsevier

American Heart Journal

Volume 146, Issue 4, October 2003, Pages 736-740
American Heart Journal

Clinical investigation: congestive heart failure
Screening for left ventricular systolic dysfunction among patients with risk factors for heart failure

https://doi.org/10.1016/S0002-8703(03)00396-XGet rights and content

Abstract

Background

The prevalence of left ventricular systolic dysfunction (LVSD) among individuals at risk for heart failure (HF) and the feasibility of screening have not been clearly defined. This study determined the prevalence of LVSD with the use of a limited screening echocardiogram among patients with risk factors for HF but no prior HF.

Methods

General medicine patients ≥60 years of age with hypertension, diabetes, coronary artery disease, or previous myocardial infarction (MI) but no history of HF or reduced left ventricular ejection fraction (LVEF) were eligible. Medical history and symptoms of breathlessness were determined by interview and chart review; consenting patients underwent electrocardiography and echocardiography. The outcome was LVEF ≤45%, based on visual estimation from the echocardiogram.

Results

Of the 482 patients who completed the study, only 1 patient could not have the LVEF visually estimated. A total of 7.9% of patients had LVEF ≤45%. The prevalence was 15.4% among those with a prior MI and 6.7% among those without prior MI. In multivariate analysis, prior MI (adjusted odds ratio, 2.75; 95% CI, 1.14 to 6.64) and probable or definite left ventricular hypertrophy by electrocardiography (adjusted odds ratio, 3.57; 95% CI, 1.22 to 10.48) were the strongest predictors of LVEF ≤45%.

Conclusions

Screening for LVSD among high-risk patients is feasible and has substantial yield, even among patients without prior MI. In light of the low cost of screening and the available therapies to prevent progression of LVSD to overt HF, controlled clinical trials of screening high-risk subgroups appear to be justified.

Section snippets

Study population

This study was approved by the MetroHealth Medical Center Institutional Review Board. Patients were recruited from the General Medicine and Geriatric clinics at MetroHealth between March 1998 and June 2000. Eligibility criteria included age ≥60 years; a history of hypertension, diabetes, or coronary artery disease (CAD, including prior myocardial infarction (MI), angina, or revascularization procedure); and no history of heart failure or documented reduced left ventricular ejection fraction

Results

Of the 1809 patients screened for the study, 78 (4.3%) refused to be interviewed and 760 (42.0%) were ineligible because they lacked risk factors for heart failure or they had a previous history of heart failure. Of the 971 eligible patients, 510 participated (51.6%). The average time (±SD) to complete the screening echocardiogram was 6.5 (±3.0) minutes. Of the 510 participants, 28 (5.5%) were excluded because prior heart failure or low LVEF was documented in their chart. Only one patient was

Discussion

Screening patients at high risk for development of heart failure with a limited echocardiogram is feasible and identifies a significant number of patients with LVSD. Patients with a past history of MI and those with definite or probable LVH by electrocardiography are particularly at risk. Patients with CAD who had not had a previous MI and those with a history of stroke were also had a higher risk of LVSD, but these trends did not reach statistical significance. Our ability to determine

Acknowledgements

We would like to thank Miriam Palmer, Annitta Morehead, Dr James Thomas, and the cardiac sonographers at MetroHealth Medical Center.

References (23)

  • K.K. Ho et al.

    The epidemiology of heart failurethe Framingham Study

    J Am Coll Cardiol

    (1993)
  • Cited by (34)

    • Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department

      2012, European Journal of Internal Medicine
      Citation Excerpt :

      In a hypertensive population 6.5% of the patients had AAA [24]. Baker et al. screened patients with previous myocardial infarction and found that 15.4% had left ventricular ejection fraction < 45% [23]. An argument against screening may be incidental findings (IF).

    • Natriuretic Peptides

      2007, Journal of the American College of Cardiology
      Citation Excerpt :

      However, large-scale studies are needed to evaluate the incremental value and cost-effectiveness of using NPs in this setting. Screening populations at high risk for development of HF, such as diabetic and elderly patients, and referring those with elevated NP levels for echocardiogram might in fact prove cost-effective despite the higher prevalence of elevated NP levels in these populations (119,120). Heidenreich et al. (120) recently found that using a BNP cutoff level of 24 pg/ml for echocardiogram referral was a cost-effective means of screening for LV dysfunction in populations (such as men over age 60 years and possibly women over age 60 years) with a prevalence of LV systolic dysfunction of at least 1%.

    • Prevalence and prognosis of left ventricular systolic dysfunction in asymptomatic diabetic patients without known coronary artery disease referred for stress single-photon emission computed tomography and assessment of left ventricular function

      2007, American Heart Journal
      Citation Excerpt :

      Population-based screening studies generally have not focused on only diabetic subjects. Such studies reported varying and generally lower estimates (3.7%-14.9%) of reduced LVEF but included a mixture of subjects with and without cardiac symptoms, known CAD, and diabetes.15-21 The highest prior prevalence estimate in diabetic patients (14.7%) was reported by the Echocardiographic Heart of England screening study, where investigators used a cutoff LVEF of 50% and included both symptomatic and asymptomatic diabetic subjects with and without known CAD.19

    View all citing articles on Scopus

    This project was supported by grant 9740079N from the American Heart Association.

    View full text